In today's landscape, many large self-funded benefit plans rely heavily on outsourcing for their medical and Rx claims administration. But how were things set up initially? That's where medical and PBM RFP consulting is valuable. Setting up favorable agreements with third-party administrators (TPAs) and pharmacy benefit managers (PBMs) is essential. Given that medical and Rx claims tend to be...
The role of medical claim auditors is to assist clients, typically self-funded medical and pharmacy plans, in identifying errors. These mistakes can arise from human error or systemic issues, but either way, they can accumulate quickly, especially in larger plans and during unexpected events like the recent COVID-19 pandemic. With significant financial implications at stake, even the...
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